The object of this study is to investigate optimal BP target and adequate management of BP in prevalent dialysis patients group.Design and Method:
The data were retrieved from End-stage Renal Disease-Clinical Research Center (ESRD-CRC) which dialysis patients were prospectively enrolled from 2009 to 2014. Total 2,299 prevalent dialysis patients were analyzed. Eligible patients were assigned to four groups according to distribution of systolic BP (SBP, group as SBP <120, 120–140, 140–160, and >160 mmHg, respectively). The primary outcome was all-cause mortality.Results:
Among the study subjects, there were 360, 862, 719, and 358 patients in each SBP groups. The mean SBP in each group was 106.9, 128.6, 146.4 and 170.9 mmHg, respectively (P < 0.001). Baseline characteristics among the groups did not show significant differences except number of AHAs (1.5 ± 1.4, 1.8 ± 1.5, 2.1 ± 1.4, and 2.3 ± 1.3 in each group, P < 0.001). During a median follow up of 4.5 years, all-cause mortality was significantly higher in SBP <120 mmHg group (hazard ratio [HR] 1.44, confidential interval [CI] 1.06–1.94, P = 0.019), and the tendency with higher risk was revealed in >160 mmHg group (HR 1.33, CI 0.94–1.81, P = 0.074) compared to groups, whose BP ranged from 120 to 160 mmHg. Multiple Cox analysis revealed that SBP <120 and >160 mmHg group had significantly higher risk of all-cause mortality after adjustment for multiple confounding factors (HR 1.84, CI 1.27–2.66, P = 0.001; HR 1.69, CI 1.16–2.45, P = 0.006). However, the number of AHAs being taken was not associated with survival rate in subgroup analysis with each BP group.Conclusions:
This study showed that lowest (<120) or highest (>160 mmHg) SBP group had significantly higher risk of all-cause mortality, irrespective of number of AHAs. BP control with optimal target is significantly associated with better survival rate. Further study is warranted to determine optimal blood pressure target in dialysis patients.